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Clinical relevance of third permanent molars in relation to crowding after orthodontic treatment.

OBJECTIVES: The purpose of this study was to determine the relationship between dental crowding and the clinical presence or absence of third permanent molar teeth. METHODS: Ninety-nine patients were analysed before and after orthodontic treatment and at least three years after the end of retention. The sample consisted of four groups: subjects whose third permanent molar teeth had erupted into the mouth, were non-erupted, were extracted, and were congenitally absent. Arch Length Discrepancy, Irregularity Index and observer bias were examined. Multivariate analysis of variance with repeated measurements was used to analyse differences between the four groups. RESULTS: Significant differences in Arch Length Discrepancy during time were shown between the premolar segment and the frontal area. The group with third permanent molar teeth congenitally missing showed a significant higher positive Arch Length Discrepancy in the premolar segment of the upper jaw. No significant differences in Irregularity Index were found between the third molar groups. CONCLUSIONS: It can be concluded that there is no relation between crowding and the presence or absence of third permanent molar teeth.

Adolescent↗

Lingual exposure during mandibular third molar surgery.

The necessity for surgical exposure of the lingual aspect of mandibular third molars will vary according to the severity of the impaction and the surgical technique adopted. A retractor is described for use in those cases when major lingual retraction is required. The retractor provides optimum access to the mandibular third molar area with adequate protection for the lingual nerve, tongue retraction and enhanced illumination by light reflection. It can be used under both local and general anaesthesia.

Dental Instruments↗

Root resorption of upper permanent incisor caused by impacted canine. An analysis of 23 cases.

Unusual root resorption of 12 central and 11 lateral upper permanent incisors in 11 patients is described. The degree of resorption ranged from loss of the apical 1/4 to almost complete loss of root structure. Excepting 1 case, permanent canines were partially or completely impacted and their crowns were in close apposition to the resorbed surfaces of the incisors. The roots of the canines were either in the process of formation or completely formed. The findings suggest that the pressure from the canine which persists in moving downward despite the lack of space to permit normal eruption could cause root resorption of adjacent incisors even in the absence of systemic factors. Of 14 extracted incisors, 10 were replaced orthodontically by the impacted canines, whereas the spaces of the extracted incisors were restored by prosthetic means in the 4 other cases. 6 incisors were preserved without any treatment and 2 with the aid of a sapphire dento-osseous anchor pin. Since the resorbed incisors were mostly free of pain, early detection by radiographic examination is essential to establish a proper diagnosis.

Adolescent↗

Indications for surgical removal of supernumerary teeth in the premaxilla.

Usually supernumerary teeth in the maxilla are removed surgically, often due to retention of the permanent teeth in the region, but in certain cases the supernumerary teeth do not cause alterations in the eruption, position or integrity of the permanent dentition. This study was performed in order to review the indications for such surgical removal. The patient records of 208 patients with supernumerary teeth during the period of 1970-81 were reviewed retrospectively. Of these patients, 52 non-operated were furthermore examined clinically and radiographically in 1982; mean observation time 7.3 years (1-22 years). Results showed that none of the 52 non-operated patients had any symptoms or pathologic conditions related to the supernumerary teeth. In 37%, progressive resorption of the supernumerary teeth was seen, and in 24% the pericoronary space was markedly reduced compared to the first examination. The position and morphology was found to have influence on the prevalence of retention of the permanent incisors (p less than 0.0001). Widening of the pericoronary space during the observation period of the non-operated patients was not seen in any of the cases. Of the total of 262 teeth, 2 well-defined pericoronary cyst (pericoronary space greater than or equal to 5 mm) were found. From the present study, it is concluded that supernumerary teeth in the premaxilla may cause pathological conditions. However, each case must be considered individually concerning surgical treatment, and if no retention of permanent teeth or pathological conditions are present, observation with regularly radiographic controls is advisable. Enlarged pericoronary space (1-3 mm) does not alone seem to indicate surgical treatment.

Adolescent↗

Changes of the facial skeleton in cases of neurofibromatosis.

In 12 patients with neurofibromatosis of the maxillofacial region distinct changes of the facial skeleton were found, which in localisation and extent largely conformed to the more or less wide soft tissue hyperplasias. In pronounced cases, a combined maxillo-zygomatico-temporo-mandibular hypoplasia was present radiographically. These skeletal changes hardly can be interpreted as pressure atrophy caused by the adjacent neurofibromatous tumours; more likely they are the result of complex developmental disorders. A more detailed explanation possibly will be obtained, when development and skeletal changes are controlled radiographically over a long period of time.

Adult↗

Dental corrective procedures.

This article explains what is needed for successful extraction of diseased cheek teeth and how to realign the occlusal surface. Incisor teeth procedures and correcting abnormalities of cheek tooth crown wear are also discussed along with wolf and floating teeth.

Animals↗

Spontaneous reeruption of a secondarily retained permanent lower molar and an unusual migration of a lower third molar.

Secondary retention refers to cessation of eruption of a tooth after its emergence. It occurs mainly in the deciduous dentition, but it is also seen on rare occasions in the permanent dentition. Although ankylosis has been suggested as the main etiologic factor, the exact biologic mechanism of secondary retention is not yet known. This article presents a case of spontaneous reeruption of a secondarily retained permanent molar, which is very rare. It also describes an unusual migration of a lower third molar in the same patient.

Adult↗

Orthodontic management of ankylosed permanent posterior teeth: a clinical report of three cases.

Ankylosed permanent posterior teeth may have a better prognosis than has been generally assumed. Three case reports offer testimony to the effectiveness of surgical luxation (loosening) with forced eruption induced by elastic force. Individual teeth, the occlusion, and the alveolar process may be preserved by early and aggressive treatment. The prognosis may be questionable, but the effect is preferable to premature extraction.

Adolescent↗

A case of hyperodontia with twenty-two supernumeraries: its surgical-orthodontic treatment.

A 10.1-year-old boy showed no permanent teeth, with the exception of the lower central incisors. An x-ray examination revealed that eruption of the permanent dentition was obstructed by 1 deciduous supernumerary and 22 permanent supernumeraries ectopically. Treatment consisted of the following steps: (1) extracting all deciduous and supernumerary teeth; (2) waiting for the roots of the permanent teeth to develop and fitting two temporary partial prostheses; (3) assisting eruption of the permanent teeth by removing the bone that covers the remaining teeth and applying crowns to stimulate the eruption; and (4) bringing the permanent teeth into occlusion with orthodontic treatment. The problem of limiting treatment time was made more difficult by the amount of repositioning needed to bring the teeth into occlusion and by delayed root formation. Therefore the orthodontist decided to use extreme caution in applying forces; as a result, treatment time was lengthened. Success was due to good teamwork between the surgeon with an orthodontic background and the orthodontist, who was familiar with surgical procedures.

Child↗

Cleidocranial dysplasia: Part 1--General principles of the orthodontic and surgical treatment modality.

Over several decades, occasional reports of dental treatment provided by an individual practitioner to patients suffering with cleidocranial dysplasia have appeared in the literature. In the past, the main treatment was prosthetic replacement. Orthodontic treatment has only recently been considered as a serious treatment option, with success being described in several aspects of this treatment modality, in published individual case reports. Given the rarity of the condition, guidelines for the treatment of cleidocranial dysplasia are difficult to find in the literature, because few practitioners have treated enough cases to be in a position to make such recommendations. Two different approaches have been proposed in the past and are discussed here. The relative advantages of a third approach are expounded in detail.

Child↗

On the phenomenon of intraosseous migration of nonerupting teeth.

Little is know about intraosseous migration of nonerupting teeth, a rare natural condition of horizontal tooth movement and impaction. It occurs only in the mandible and involves primarily the second premolar or the canine. When the second premolar is the affected tooth, it always is found distal to its normal position. The origins of the second premolar intraosseous migration phenomenon are obscure and usually no treatment is recommended. Intraosseous migration involving the canine is commonly called transmigration because the affected canine moves mesially across the mandibular symphysis to the opposite side of the mandible. Analysis of 50 published cases of canine transmigration indicated higher occurrence in women and no sidedness preference. In over 80% of the studied cases, the canine remained nonerupted and, of the 24 cases receiving some treatment, all but two underwent extraction of the anomalous canine. The canine transmigration phenomenon appears to show signs of having some genetic determinants.

Bicuspid↗

Eruption disturbances of the first and second permanent molars: results of treatment in 43 cases.

Impaction or retention of first and second permanent molars is an uncommon condition with diverse therapeutic approaches. To ascertain the success rate of different treatment possibilities, a retrospective study was made of 25 patients with a total of 43 permanent molars with eruption disturbances. In most cases, the nonerupted teeth were mandibular second molars (65%), followed by maxillary second molars (21%). Their position, degree of impaction (inclusion), clinical features, repercussion on the neighboring teeth, type of treatment, and outcome were evaluated. Infraocclusion was often associated with malposition of neighboring teeth, as well as extrusion and infraocclusion of opposing teeth. Due mostly to a delay in the diagnosis of the condition, an acceptable final position of the nonerupted molar was obtained in only 8 of 13 conservatively treated second molars. In order to prevent this situation, radiographic examination (ideally during the early mixed dentition period) and early diagnosis of eruption disturbances of permanent first and second molars are recommended, particularly when considering that these anomalies are associated with a high rate of occlusal disturbances that may require orthodontic correction.

Adolescent↗

Apparent hypodontia: a case of misdiagnosis.

The case of a 12-year-old girl is reported, whose pretreatment radiograph demonstrated agenesis of two premolars and a canine and slow development of the contralateral premolars. A follow-up radiograph taken 1 year later showed initial mineralization of a tooth germ in the site of one of the apparently missing premolars. The cause, diagnosis, and treatment planning implications of delayed mineralization and slow development of second premolars are discussed with reference to the literature.

Anodontia↗

Regional odontodysplasia: report of three cases.

Regional odontodysplasia is a developmental anomaly of dental tissues with characteristic clinical, radiographic, and histologic appearances. It most commonly affects the maxillary anterior teeth of both the primary and permanent dentition, and occurs in females twice as often as in males. The pathogenesis is unknown. The clinical and histopathologic findings of regional odontodysplasia in three patients are discussed.

Adolescent↗

Amelogenesis imperfecta and nephrocalcinosis syndrome. Case studies of clinical features and ultrastructure of tooth enamel in two siblings.

This article describes the enamel ultrastructure and clinical features in two siblings with the little known syndrome of Amelogenesis imperfecta and nephrocalcinosis. Nephrocalcinosis was diagnosed by x-ray examination of the abdomen, intravenous pyelography, ultrasonography, and computed tomography scan. Amelogenesis imperfecta was diagnosed from clinical and histologic examinations. The affected enamel was hypoplastic (approximately 0.2 mm thick), positively birefringent, generally aprismatic, porous, and consisted of loosely packed, randomly orientated, thin (approximately 10 nm wide), ribbonlike crystals. The enamel surface was rough, extensively cracked, and covered with ovoid or globular protrusions. Observations showed that in this case hypoplasia, hypocalcification, or hypomaturation defects were present in the same tooth, indicating that both secretory and maturation phases may have been affected. The study suggested the possibility of an abnormality in interstitial matrix, which could lead to dystrophic calcification in the kidney and abnormal tooth enamel formation. It also suggested the possibility of involvement of two separate but closely linked genes.

Adolescent↗